Epilepsy and Pregnancy

What is epilepsy?

Epilepsy, also called a seizure disorder, is defined as a neurological disorder that involves recurrent seizures. According to the National Institute of Neurological Disorders and Stroke (NINDS), it is estimated that epilepsy affects 1 percent of the U.S. population (more than 2 million people).

Transmission of information from nerve cell to nerve cell occurs by electrochemical process. Abnormal patterns in the electrical activity may cause seizures. A seizure disorder includes any condition in which there are repeated episodes of seizures of any type.

What are the symptoms of epilepsy?

Epilepsy is characterized by seizures of any type that occur on a chronic, recurrent basis and have no known cause. In addition to seizures, the following are the most common symptoms of epilepsy. However, each individual may experience symptoms differently. Symptoms may include:

Headache

Changes in mood or energy level

Dizziness

Fainting

Confusion

Memory loss

Some people may also experience an aura--sensation that indicates a seizure is imminent just prior to onset. The symptoms of epilepsy may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How does pregnancy affect epilepsy?

About 25 to 40 percent of women with epilepsy have more frequent seizures during pregnancy. This is especially true in women who already have frequent seizures. This may be because medications to treat epilepsy tend to work differently during pregnancy. They may not be absorbed as well or may not be as effective. Women who have nausea and vomiting in early pregnancy are more likely to vomit the medication before the medication has its full effect.

How does epilepsy affect pregnancy?

General complications from epilepsy may include, but are not limited to, the following:

Injury from such actions as falls, bumps, or biting self

Injury from having a seizure while driving or operating machinery

Aspiration of fluid into the lungs and subsequent pneumonia

Permanent brain damage (stroke or other damage)

Difficulty with learning

Side effects from medications

Death or permanent brain damage from seizures is rare, but can occur. Death or brain damage are most often caused by prolonged lack of breathing and death of brain tissue from lack of oxygen.

Epilepsy and the medications to treat it can have many effects on the mother, the pregnancy, and the fetus and newborn. Fortunately, most women are able to have a healthy pregnancy and baby. However, epilepsy does increase the risks for certain complications of pregnancy. These include the following:

Stillbirths

Slightly smaller babies

Pregnancy-induced hypertension (high blood pressure of pregnancy)

Medications taken to treat epilepsy are called anticonvulsants, or antiepileptic drugs. These drugs have many effects on the pregnant woman's body. Some anticonvulsant drugs may interfere with the levels of folic acid in the blood. Research has been inconclusively in determining whether folic acid supplementation prevents neural tube defects in women receiving antiepileptic drugs; however, there is no evidence to show it will cause harm. Therefore, the American Academy of Neurology (AAN) recommends women of childbearing age on anticonvulsant medication need a folic acid supplementation of at least 0.4 mg/day before becoming pregnant and throughout pregnancy. Women with epilepsy should discuss with their health care provider exact levels of supplementation that they recommend. Other anticonvulsant medications can affect vitamin D absorption. Prenatal vitamins contain enough vitamin D to counter this problem.

There is evidence that anticonvulsant medications may be linked to birth defects. It is not clear which specific drugs cause problems and it is generally agreed that preventing seizures outweighs any risks. However, most babies born to women taking these medications do not have malformations.

Infants of mothers with epilepsy are at risk for hemorrhage (excessive bleeding). Some anticonvulsant medications can affect vitamin K, which is important in blood clotting. It is important for newborns to receive an injection of vitamin K to prevent bleeding. Newborns may have withdrawal symptoms from the mother's seizure medication, but this usually lasts only a few weeks or months and usually does not cause serious or long-term effects. A mother's seizure medication also passes through breast milk in small amounts, but generally, the benefits of breastfeeding outweigh any side effects of drowsiness or feeding difficulty for the baby.

Management of epilepsy during pregnancy

Pregnant women with epilepsy need close monitoring of the disease and of fetal health. More frequent prenatal visits are often needed. Most women are treated with anticonvulsant medications. Monitoring of these medications is important for the continued control of seizures and reduction of side effects. Using as few medications as possible and at the lowest dose needed to control seizures is the goal of treatment.

Women with epilepsy can usually labor and deliver as other women. Because stress may increase the risk of seizures, a calm environment and epidural anesthesia are often recommended.

Women with epilepsy can increase their chances for a healthy pregnancy by getting early prenatal care and working with their health care providers in the management of their disease. Always consult your doctor for more information regarding treatment for epilepsy and pregnancy.